Abstracts
Journal: Annals of the Rheumatic Diseases (1961)

In the authors' experience the clinical picture of rheu- matic fever in children has definitely changed in recent years.They base this view on 1,472 cases of the disease in children treated during the period 1953 to 1959, among whom they noted a tendency to an increased incidence among children of pre-school age.Involve- ment of the joints was much less common in 1959 (12 per cent.)than in 1953 (52 per cent.) and when it did occur it was mild and of short duration.On the other hand involvement of the vascular system was more frequent, especially in cases with atypical joint lesions, such as arthritis of a single joint or involvement of small joints only.The incidence of endomyocarditis also increased (from 45-4 per cent. of 140 cases in 1953 to 73-13 per cent. of 186 cases in 1959), while that of pancarditis diminished (from 6-4 per cent. of 140 cases in 1953 to only 1 07 per cent. of 186 cases in 1959).Clini- cally the endomyocarditis developed early (between the 5th and 7th day) and gave rise to murmurs, but not always to permanent valvular damage.At some time during the disease the electrocardiogram showed in- creased atrioventricular conduction time in 57-0 per cent. of cases and of prolonged intraventricular con- duction time in 77 4 per cent.Persistent increase of the QRS interval was observed in 27 per cent. of patients, prolongation of systole in the acute stage in 90 per cent.(although this persisted in only 7 per cent.), a low-voltage P-wave in 82 per cent., and a low-voltage T-wave in 93 per cent.(the latter recovered slowly in 66 per cent.), while other irregularities of rhythm were seen in a few cases only.In 1959, also, lesions other than cardiac were observed fairly frequently, but their prognostic significance was less serious; lesions of the lung and pleura were rare.Leucocytosis and neutrophilia were more marked in the presence of polyarthritis, polyserositis, and abdominal lesions.In young children the erythrocyte sedimentation rate sometimes remained normal; in 75-5 per cent.o these patients the onset was acute, but the course was benign and lasted less than 2 months.Over-all the proportion of acute cases fell from 88-4 per cent. in 1953 to 55 3 per cent. in 1959, and no fulminant cases were seen in the latter year.Among the other changes seen in 1959 were an increased incidence of mild chorea or chorea associated with cardiovascular involvement, and a lower incidence of septic complications.Of the 1,472 young patients treated, eighteen aged between 7 and 15 years died.Of these, two were admitted to hospital late in the first attack with cardiac failure of Grade II or III, but the other deaths occurred in the third to seventh attacks.The immediate cause of death in all cases was pancarditis and circulatory failure.The authors express the view that diagnostic difficulties seem to have increased with the increased incidence of the disease and to this factor they attribute the recently noted tendency to diagnose rheumatic fever on insufficient grounds.S. W. Waydenfeld.Rheumatic Fever in Children under 5 Years of Age.(La maladie de Bouillaud chez l'enfant de moins de 5